Commentary from Dr. Jane Morton on Hands on Pumping Study.
Our research suggests that mothers of premature infants should not rely solely on breast pumps to establish and maintain their breast milk supply. These mothers, and most likely all mothers already have a simple, safe and free tool for assisting breast milk production: their own hands. We found that the suction of an electric pump could not reliably remove a significant portion of colostrum and milk, and that massaging and compressing those areas of the breast that felt firm improved milk removal.
In our research, we taught mothers to use their hands to express colostrum (early milk) during the first three postpartum days. Once milk volume increases, they are instructed to use a technique called hands-on-pumping (using both an electric pump and hand techniques synchronously). Mothers of babies born before 30 weeks of gestation who hand-expressed colostrum more than five times a day in addition to pumping and then used hands-on-pumping for eight weeks produced an average of a quart (32 oz) of milk a day and were even able to express less frequently and sleep longer at night at eight weeks postpartum.
It was actually the study mothers who first became aware of the importance of the two skills—hand expression and hands-on pumping. Before we began to tabulate the data, our study mothers kept commenting on how much more milk they were making compared to non-study mothers. Instead of expressing appreciation for the use of a brand new top-of-the-line electric breast pump and access to lots of instruction and encouragement, their almost unanimous response regarding their experience of being in the study was the value they attached to learning how to use their hands.
This was a wonderful study to be involved in because the results were so clinically relevant. For too many years I have been relatively unsuccessful helping mothers turn around the distressing problem of having too little milk. The “take home points” of this study are:
- What happens in the first 3 days is critical to future milk production.
- There is a risk when mothers are taught to rely solely on breast pumps to establish and maintain their breast milk supply.
- Even low producing mothers can become high producers—not by expressing more frequently, but by expressing more effectively. This involves learning a simple technique called hands-on-pumping.
- So-called “risk factors” for insufficient milk production such as preterm birth, obesity, cesarean birth, advanced maternal age, first-time mother, and mother of multiples (twins, triplets or more) seem to be of little consequence when effective expression techniques are utilized.
Our study involved only mothers who delivered prematurely and were most likely to have low milk production. However, there is no reason to think that these techniques would not be just as effective, or even more effective for mothers of near-term or term babies. Late pre-term infants (those born between 34 and 36 weeks of gestation) are at highest risk of feeding problems related to poor milk intake, including jaundice, dehydration, and poor growth.